慢性阻塞性肺疾病伴肺动脉高压患者血清MMP-9、TIMP-1、VIP表达及其临床意义  

Expression levels and clinical significances of serum MMP-9,TIMP-1 and VIP in chronic obstructive pulmonary disease patients with pulmonary hypertension

作　　者：王思雨 赵阿敏 Wang Siyu;Zhao Amin(Department of Respiratory and Critical Care Medicine,Xi′an Central Hospital,Xi′an 710000,China)

机构地区：[1]西安市中心医院呼吸与危重症医学科,西安710000

出　　处：《国际呼吸杂志》2025年第3期227-233,共7页International Journal of Respiration

基　　金：陕西省重点研发计划(S2024-YF-YBSF-0089)。

摘　　要：目的探讨慢性阻塞性肺疾病(慢阻肺病)伴肺动脉高压(PH)患者血清基质金属蛋白酶9(MMP-9)、金属蛋白酶1组织抑制剂(TIMP-1)、血管活性肠肽(VIP)表达及其临床意义。方法本研究为病例对照研究。采用非随机抽样法,选取2023年8月至2024年1月西安市中心医院收治的326例慢阻肺病患者作为研究对象,根据是否合并PH分为PH组(109例)和非PH组(217例),PH患者根据肺动脉收缩压(PASP)分为轻度PH组(53例)、中度PH组(29例)、重度PH组(27例)。比较2组慢阻肺病患者的临床资料和血清MMP-9、TIMP-1、VIP水平,多因素logistic回归分析慢阻肺病患者发生PH的影响因素,比较不同病情PH患者血清MMP-9、TIMP-1、VIP水平,分析慢阻肺病伴PH患者PASP与血清MMP-9、TIMP-1、VIP的相关性。结果PH组男67例(61.47%),女42例(38.53%),年龄(64.31±8.49)岁;非PH组男136例(62.67%),女81例(37.33%),年龄(63.95±8.62)岁。2组慢阻肺病患者性别、年龄差异无统计学意义(χ^(2)=0.05,P=0.832;t=0.36,P=0.721)。PH组血清MMP-9、TIMP-1水平高于非PH组[MMP-9:(168.54±20.85)μg/L比(95.72±16.83)μg/L,t=33.95,P<0.001;TIMP-1:(229.41±23.81)μg/L比(126.49±22.75)μg/L,t=37.94,P<0.001],血清VIP水平低于非PH组[(35.76±5.83)μg/L比(42.39±5.52)μg/L,t=10.04,P<0.001]。logistic回归分析显示,合并单纯性夜间低氧血症(OR=3.326,95%CI:2.185~5.062)、右心房内径增宽(OR=3.168,95%CI:2.051~4.892)、右心室内径增宽(OR=3.317,95%CI:2.193~5.016)、动脉血二氧化碳分压升高(OR=3.600,95%CI:2.206~5.875)及血清MMP-9升高(OR=5.663,95%CI:3.981~8.056)、TIMP-1升高(OR=4.805,95%CI:3.255~7.092)是慢阻肺病患者发生PH的独立危险因素;动脉血氧分压升高(OR=0.348,95%CI:0.236~0.514)、VIP水平升高(OR=0.305,95%CI:0.197~0.471)是慢阻肺病患者发生PH的独立保护因素;重度PH组血清MMP-9、TIMP-1水平高于中度、轻度PH组,血清VIP水平低于中度、轻度PH组(均P<0.05);中度PH组血清MMP-9、TIMP-1水平高于轻度PH�ObjectiveTo explore the expression levels and clinical significances of serum matrix metalloproteinase 9(MMP-9),tissue inhibitor of metalloproteinase-1(TIMP-1),and vasoactive intestinal peptide(VIP)in patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PH).MethodsThis was a case-control study.A total of 326 COPD patients admitted to Xi′an Central Hospital from August 2023 to January 2024 were selected as the research subjects by non-random sampling method.According to the presence or absence of PH,they were divided into the PH group(109 cases)and non-PH group(217 cases).PH patients were further divided into the mild PH group(53 cases),moderate PH group(29 cases),and severe PH group(27 cases)according to the pulmonary artery systolic pressure(PASP).The clinical data and serum levels of MMP-9,TIMP-1,and VIP were compared between the two groups.Multivariate logistic regression analysis was performed to identify the influencing factors for PH in COPD patients.Serum levels of MMP-9,TIMP-1,and VIP in COPD patients with varying severities of PH were compared,and the correlations of PASP with serum MMP-9,TIMP-1,and VIP in COPD patients with PH were analyzed.ResultsIn the PH group,there were 67(61.47%)males and 42(38.53%)females,with an average age of 64.31±8.49 years.In the non-PH group,there were 136(62.67%)males and 81(37.33%)females,with an average age of 63.95±8.62 years.There were no significant differences in the gender(χ^(2)=0.05,P=0.832)and age(t=0.36,P=0.721)between the two groups.Serum levels of MMP-9(168.54±20.85μg/L vs 95.72±16.83μg/L,t=33.95,P<0.001)and TIMP-1(229.41±23.81μg/L vs 126.49±22.75μg/L,t=37.94,P<0.001)in the PH group were significantly higher than those of the non-PH group,while serum VIP level was significantly lower(35.76±5.83μg/L vs 42.39±5.52μg/L,t=10.04,P<0.001).Multivariate logistic regression analysis showed that the presence of isolated nocturnal hypoxemia(OR=3.326,95%CI:2.185-5.062),increased right atrial diameter(OR=3.168,95%C

关 键 词：肺疾病 慢性阻塞性 高血压 肺性 基质金属蛋白酶9 金属蛋白酶1组织抑制剂 血管活性肠肽 肺血管重塑 

分 类 号：R563[医药卫生—呼吸系统]